| Entity Name: | PAUL D. JAYACHANDRA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Mar 1999 (26 years ago) |
| Document Number: | P99000026368 |
| FEI/EIN Number | 593573936 |
| Address: | 1680 OSCEOLA ELEM SCHOOL RD, STE A, SAINT AUGUSTINE, FL, 32084 |
| Mail Address: | 1680 OSCEOLA ELEM SCHOOL RD, STE A, SAINT AUGUSTINE, FL, 32084 |
| ZIP code: | 32084 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1295870830 | 2007-02-21 | 2007-10-22 | 1680 OSCEOLA ELEMENTARY SCHOOL ROAD, SUITE A, ST AUGUSTINE, FL, 32084, US | 1680 OSCEOLA ELEMENTARY SCHOOL ROAD, SUITE A, ST AUGUSTINE, FL, 32084, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-824-7476 |
| Fax | 9048247870 |
Authorized person
| Name | JENNIFER RAE FAIRCLOTH |
| Role | OFFICE MANAGER |
| Phone | 9048247476 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0066989 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FLORIDA |
| Number | 26220 |
| State | FL |
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 26220Y |
| State | FL |
| Issuer | AETNA |
| Number | 5777008 |
| State | FL |
| Issuer | WAUSA BENIFITS |
| Number | 94163841 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | AA919 |
| State | FL |
| Issuer | AVMED |
| Number | 206068 |
| State | FL |
| Issuer | MEDICAID |
| Number | 376531801 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 390006717 |
| State | FL |
| Issuer | UNITED HEALTHCARE |
| Number | 110132302 |
| State | FL |
| Issuer | MEDICARE PTAN NUMBER |
| Number | 26220Y |
| State | FL |
| Issuer | WELLCARE |
| Number | 150095 |
| State | FL |
| Issuer | HEALTHEASE |
| Number | 150095 |
| State | FL |
| Issuer | MEDICAID |
| Number | 376531800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FARAH LAW | Agent | 6550 ST. AUGUSTINE ROAD, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| JAYACHANDRA PAUL D | President | 1680 OSCEOLA ELEM SCHOOL RD STE A, SAINT AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| JAYACHANDRA PAUL D | Secretary | 1680 OSCEOLA ELEM SCHOOL RD STE A, SAINT AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| JAYACHANDRA PAUL D | Treasurer | 1680 OSCEOLA ELEM SCHOOL RD STE A, SAINT AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| JAYACHANDRA PAUL D | Director | 1680 OSCEOLA ELEM SCHOOL RD STE A, SAINT AUGUSTINE, FL, 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-02-26 | FARAH LAW | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-26 | 6550 ST. AUGUSTINE ROAD, Suite 103, JACKSONVILLE, FL 32217 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-05-27 | 1680 OSCEOLA ELEM SCHOOL RD, STE A, SAINT AUGUSTINE, FL 32084 | No data |
| CHANGE OF MAILING ADDRESS | 2002-05-27 | 1680 OSCEOLA ELEM SCHOOL RD, STE A, SAINT AUGUSTINE, FL 32084 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-02-26 |
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-03-05 |
| ANNUAL REPORT | 2018-03-22 |
| ANNUAL REPORT | 2017-03-16 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-02-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
