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  5. THEO MEDICAL DERMATOLOGY, LLC

THEO MEDICAL DERMATOLOGY, LLC

Company Details

Entity Name: THEO MEDICAL DERMATOLOGY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 30 Jan 2013 (12 years ago)
Last Event: LC AMENDMENT AND NAME CHANGE
Event Date Filed: 21 May 2013 (12 years ago)
Document Number: L13000016096
FEI/EIN Number 46-1920858
Address: 3030 E. Semoran Blvd, Suite 258, Apopka, FL 32703
Mail Address: 3030 E SEMORAN BLVD, SUITE 258, APOPKA, FL 32703
ZIP code: 32703
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558707588 2013-05-16 2024-06-04 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 327035900, US 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 327035900, US

Contacts
Phone +1 407-671-3634
Fax 4079866033

Authorized person
Name ATHENA THEODOSATOS
Role OWNER
Phone 4076713634

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number OS38457
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 001101800
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 461920858 2023-10-09 THEO MEDICAL DERMATOLOGY LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 60642

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing MILETA THEODOSAT
Valid signature Filed with authorized/valid electronic signature
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 461920858 2023-10-09 THEO MEDICAL DERMATOLOGY LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 32703

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing MILETA THEODOSAT
Valid signature Filed with authorized/valid electronic signature
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 461920858 2023-10-09 THEO MEDICAL DERMATOLOGY LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 32703

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing MILETA THEODOSAT
Valid signature Filed with authorized/valid electronic signature
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 461920858 2023-10-04 THEO MEDICAL DERMATOLOGY LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 32703

Signature of
Role Plan administrator
Date 2023-10-04
Name of individual signing MILETA THEODOSAT
Valid signature Filed with authorized/valid electronic signature
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 461920858 2023-10-09 THEO MEDICAL DERMATOLOGY LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 32703

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing MILETA THEODOSAT
Valid signature Filed with authorized/valid electronic signature
THEO MEDICAL DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 461920858 2021-08-11 THEO MEDICAL DERMATOLOGY LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621330
Sponsor’s telephone number 4076713634
Plan sponsor’s address 3030 E SEMORAN BLVD STE 258, APOPKA, FL, 32703

Signature of
Role Plan administrator
Date 2021-08-11
Name of individual signing PAUL NEUMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NEUMAN, PAUL ELMER Agent 3030 E. Semoran Blvd, Suite 258, Apopka, FL 32703

Manager

Name Role Address
THEODOSATOS, ATHENA, DO, MPH Manager 3030 E SEMORAN BLVD, SUITE 258 APOPKA, FL 32703
NEUMAN, PAUL ELMER Manager 3030 E SEMORAN BLVD, SUITE 258 APOPKA, FL 32703

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2018-02-21 3030 E. Semoran Blvd, Suite 258, Apopka, FL 32703 No data
CHANGE OF PRINCIPAL ADDRESS 2017-02-02 3030 E. Semoran Blvd, Suite 258, Apopka, FL 32703 No data
REGISTERED AGENT ADDRESS CHANGED 2017-02-02 3030 E. Semoran Blvd, Suite 258, Apopka, FL 32703 No data
REGISTERED AGENT NAME CHANGED 2015-04-28 NEUMAN, PAUL ELMER No data
LC AMENDMENT AND NAME CHANGE 2013-05-21 THEO MEDICAL DERMATOLOGY, LLC No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J17000549669 LAPSED CACE17017937 17TH CIRCUIT BROWARD COUNTY 2017-06-29 2022-10-09 $15,876.86 DE LAGE LANDEN, 1111 OLD EAGLE SCHOOL ROAD, WAYNE, PA

Documents

Name Date
ANNUAL REPORT 2024-02-12
ANNUAL REPORT 2023-04-08
ANNUAL REPORT 2022-03-28
ANNUAL REPORT 2021-02-13
ANNUAL REPORT 2020-02-20
ANNUAL REPORT 2019-04-25
ANNUAL REPORT 2018-02-21
ANNUAL REPORT 2017-02-02
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-04-28

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2619697408 2020-05-06 0491 PPP 3030 SEMORAN BLVD, APOPKA, FL, 32703
Loan Status Date 2021-08-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 151910
Loan Approval Amount (current) 151910
Undisbursed Amount 0
Franchise Name -
Lender Location ID 123987
Servicing Lender Name Cogent Bank
Servicing Lender Address 420 S Orange Ave, Ste 150, ORLANDO, FL, 32801
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address APOPKA, ORANGE, FL, 32703-0001
Project Congressional District FL-07
Number of Employees 17
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 123987
Originating Lender Name Cogent Bank
Originating Lender Address ORLANDO, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 153758.24
Forgiveness Paid Date 2021-07-26

Related by officers

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Date of last update: 22 Feb 2025

Sources: Florida Department of State

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