| Entity Name: | BUDDHA P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Feb 2019 (6 years ago) |
| Date of dissolution: | 28 Jan 2021 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Jan 2021 (4 years ago) |
| Document Number: | P19000017620 |
| FEI/EIN Number | 850595038 |
| Address: | 1731 Banaghen Dr, Melbourne, FL, 32940, US |
| Mail Address: | 1731 Banaghen Dr, Melbourne, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144842246 | 2020-05-12 | 2020-07-09 | 1731 BANAGHEN DR, MELBOURNE, FL, 329406012, US | 1731 BANAGHEN DR, MELBOURNE, FL, 329406012, US | |||||||||||||||||||
|
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| Phone | +1 614-404-0972 |
Authorized person
| Name | CHAITHANYA DEEPTHI BUDDHA |
| Role | PRESIDENT |
| Phone | 6144040972 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE CROSS BLUE SHIELD |
| Number | 14Y3K |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BUDDHA DEEPTHI | Agent | 1731 BANAGHEN WAY, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| BUDDHA DEEPTHI | President | 1731 BANAGHEN DR, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-01-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-07-06 | 1731 Banaghen Dr, Melbourne, FL 32940 | No data |
| CHANGE OF MAILING ADDRESS | 2020-07-06 | 1731 Banaghen Dr, Melbourne, FL 32940 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-01-28 |
| ANNUAL REPORT | 2020-07-28 |
| Domestic Profit | 2019-02-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
