| Entity Name: | SRIDHARA SASTRY MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Oct 1999 (25 years ago) |
| Document Number: | P99000093406 |
| FEI/EIN Number | 593603023 |
| Address: | PEDIATRIC CRITICAL CARE ASSOC.,, 5003 E. LONGBOAT BLVD, TAMPA, FL, 33615, US |
| Mail Address: | 5003 EAST LONG BOAT BOULEVARD, TAMPA, FL, 33615 |
| ZIP code: | 33615 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770686974 | 2006-09-06 | 2012-10-08 | PO BOX 21727, TAMPA, FL, 336221727, US | 5003 E LONGBOAT BLVD, TAMPA, FL, 336154229, US | |||||||||||||||||||||||
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| Phone | +1 727-823-2188 |
| Fax | 7278239502 |
| Phone | +1 813-855-7884 |
Authorized person
| Name | SRIDHARA SASTRY |
| Role | OWNER / PROVIDER |
| Phone | 8138557884 |
Taxonomy
| Taxonomy Code | 2080P0203X - Pediatric Critical Care Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 045861900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEDIATRIC CRITICAL CARE ASSOC., | Agent | 5003 EAST LONG BOAT BOULEVARD, TAMPA, FL, 33615 |
| Name | Role | Address |
|---|---|---|
| SASTRY SRIDHARA | President | 5003 E LONGBOAT BLVD, TAMPA, FL, 33615 |
| Name | Role | Address |
|---|---|---|
| SASTRY INDIRA | Vice President | 5003 EAST LONGBOAT BLVD, TAMPA, FL, 33615 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2007-03-05 | PEDIATRIC CRITICAL CARE ASSOC.,, 5003 E. LONGBOAT BLVD, TAMPA, FL 33615 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-01-19 | PEDIATRIC CRITICAL CARE ASSOC., | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-18 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-02-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
