| Entity Name: | ROGER H. SHELLING, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 28 Jun 1982 (43 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | F88560 |
| FEI/EIN Number | 59-2206191 |
| Address: | 3045 Windsor Pl., Boca Raton, FL 33434 |
| Mail Address: | 3045 WINDSOR PL., BOCA RATON, FL 33434 |
| ZIP code: | 33434 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356435259 | 2006-10-03 | 2020-08-22 | 5601 N.DIXIE HIGHWAY, FT.LAUDERDALE, FL, 33334, US | 5601 N.DIXIE HIGHWAY, FT.LAUDERDALE, FL, 33334, US | |||||||||||||||||||||||||
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| Phone | +1 954-772-8207 |
| Fax | 9549388056 |
Authorized person
| Name | DR. ROGER HARRIS SHELLING |
| Role | PHYSICIAN/UROLOGIST |
| Phone | 9547728207 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| License Number | ME0035947 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 66117100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHELLING, ROGER H.,MD PA | Agent | 3045 WINDSOR PL., BOCA RATON, FL 33434 |
| Name | Role | Address |
|---|---|---|
| SHELLING, ROGER H, MD PA | Director | 3045 WINDSOR PLACE, BOCA RATON, FL 33434 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-03-22 | 3045 Windsor Pl., Boca Raton, FL 33434 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-10 | 3045 Windsor Pl., Boca Raton, FL 33434 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-10 | SHELLING, ROGER H.,MD PA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-10 | 3045 WINDSOR PL., BOCA RATON, FL 33434 | No data |
| REINSTATEMENT | 2003-12-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000362031 | TERMINATED | 1000000272166 | BROWARD | 2012-04-24 | 2032-05-02 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-22 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-05-01 |
| ANNUAL REPORT | 2011-04-29 |
| ANNUAL REPORT | 2010-03-29 |
| ANNUAL REPORT | 2009-04-12 |
| ANNUAL REPORT | 2008-01-03 |
| ANNUAL REPORT | 2007-01-05 |
| ANNUAL REPORT | 2006-01-05 |
| ANNUAL REPORT | 2005-06-29 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
