| Entity Name: | A FITTING EXPERIENCE MASTECTOMY SHOPPE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Jul 1997 (28 years ago) |
| Document Number: | P97000062813 |
| FEI/EIN Number | 650765969 |
| Address: | 2950 N. STATE ROAD 7, MARGATE, FL, 33063, US |
| Mail Address: | 2950 N. STATE ROAD 7, MARGATE, FL, 33063, US |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265433171 | 2005-08-02 | 2024-05-03 | 2950 N STATE ROAD 7 STE 103, MARGATE, FL, 330635748, US | 2950 N STATE ROAD 7 STE 103, MARGATE, FL, 330635748, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-978-8287 |
| Fax | 9549789059 |
Authorized person
| Name | BETH AGAMI |
| Role | PRESIDENT/OWNER |
| Phone | 9549788287 |
Taxonomy
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | 1187390002 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AV-MED PROVIDER NUMBER |
| Number | 283302 |
| State | FL |
| Issuer | CIGNA PROVIDER |
| Number | 9490689001 |
| State | FL |
| Issuer | BC/BS OF FLORIDA-MARGATE |
| Number | M2726 |
| State | FL |
| Issuer | BC/BS OF FLORIDA |
| Number | M2420 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AGAMI BETH | Agent | 2000 S. Ocean Blvd., Boca Raton, FL, 33432 |
| Name | Role | Address |
|---|---|---|
| AGAMI BETH R | President | 8058 LIBERTY WAY, PARKLAND, FL, 33067 |
| Name | Role | Address |
|---|---|---|
| COLE GOLDIE | Secretary | 3379 SW 50 STREET, FORT LAUDERDALE, FL, 33312 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08190900140 | BRAS GALORE & MORE! | EXPIRED | 2008-07-08 | 2013-12-31 | No data | 1605 NORTH STATE ROAD 7, MARGATE, FL, 33063 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
