| Entity Name: | SUNCOAST DERMPATH LABORATORY & CONSULTATION, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 08 Sep 2009 (15 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L09000087031 |
| FEI/EIN Number | 27-0939607 |
| Address: | 4431 WALTHAM DRIVE, TAMPA, FL 33634 |
| Mail Address: | 4431 WALTHAM DRIVE, TAMPA, FL 33634 |
| ZIP code: | 33634 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013239219 | 2010-02-16 | 2011-09-02 | 4431 WALTHAM DR, TAMPA, FL, 336347345, US | 4431 WALTHAM DR, TAMPA, FL, 336347345, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-598-2893 |
| Fax | 8884278643 |
Authorized person
| Name | DR. SHURUN ZHAO |
| Role | PRESIDENT |
| Phone | 8135982893 |
Taxonomy
| Taxonomy Code | 207ND0900X - Dermatopathology Physician |
| License Number | ME99158 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207ZP0102X - Anatomic Pathology & Clinical Pathology Physician |
| License Number | ME99158 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 280544800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZHAO, SHURUN, SHURUN ZHAO | Agent | 4431 WALTHAM DR., TAMPA, FL 33634 |
| Name | Role | Address |
|---|---|---|
| ZHAO, SHURUN | Manager | 4431 WALTHAM DRIVE, TAMPA, FL 33634 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000003058 | SUNCOAST DERMATOPATHOLOGY LAB | EXPIRED | 2012-01-09 | 2017-12-31 | No data | 4431 WALTHAM DR., TAMPA, FL, 33634 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-05-08 | ZHAO, SHURUN, SHURUN ZHAO | No data |
| REINSTATEMENT | 2019-05-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-04 | 4431 WALTHAM DR., TAMPA, FL 33634 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-12-15 | 4431 WALTHAM DRIVE, TAMPA, FL 33634 | No data |
| CHANGE OF MAILING ADDRESS | 2010-12-15 | 4431 WALTHAM DRIVE, TAMPA, FL 33634 | No data |
| LC NAME CHANGE | 2010-12-15 | SUNCOAST DERMPATH LABORATORY & CONSULTATION, LLC | No data |
| LC AMENDMENT | 2009-11-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-15 |
| REINSTATEMENT | 2019-05-08 |
| ANNUAL REPORT | 2014-01-16 |
| ANNUAL REPORT | 2013-01-25 |
| ANNUAL REPORT | 2012-01-04 |
| ANNUAL REPORT | 2011-01-04 |
| LC Name Change | 2010-12-15 |
Date of last update: 24 Feb 2025
Sources: Florida Department of State
