| Entity Name: | SANDY MARTIN DERMATOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
SANDY MARTIN DERMATOLOGY LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 10 Feb 2014 (11 years ago) |
| Date of dissolution: | 10 Jan 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 Jan 2018 (7 years ago) |
| Document Number: | L14000022606 |
| FEI/EIN Number |
46-4774988
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 13641 METROPOLIS AVENUE #102, FORT MYERS, FL, 33912, US |
| Mail Address: | 13641 METROPOLIS AVE, STE 102, FORT MYERS, FL, 33912, US |
| ZIP code: | 33912 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265856256 | 2014-02-11 | 2014-08-04 | 1090 CAMELOT CIR, NAPLES, FL, 341191308, US | 13641 METROPOLIS AVE, STE 102, FORT MYERS, FL, 339124433, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-706-5422 |
| Fax | 8889901670 |
| Phone | +1 239-208-4408 |
Authorized person
| Name | DR. SANDY MARTIN |
| Role | CHIEF EXECUTIVE MANAGER |
| Phone | 2392084408 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME30746 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | HS963A |
| State | FL |
| Issuer | MEDICARE PTAN FOR SANDY MARTIN MD |
| Number | 93792T |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SANDY MARTIN DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN | 2017 | 464774988 | 2018-02-20 | SANDY MARTIN DERMATOLOGY, LLC | 4 | |||||||||||||||||||||||
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| SANDY MARTIN DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN | 2016 | 464774988 | 2017-02-14 | SANDY MARTIN DERMATOLOGY, LLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-02-14 |
| Name of individual signing | SANDY MARTIN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MARTIN SANDY | Manager | 13641 METROPOLIS AVENUE #102, FORT MYERS, FL, 33912 |
| MARTIN SANDY | Agent | 13641 METROPOLIS AVE, FORT MYERS, FL, 33912 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000015977 | MARTIN DERMATOLOGY | EXPIRED | 2014-03-03 | 2019-12-31 | - | 1090 CAMELOT CIRCLE, NAPLES, FL, 34119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-01-10 | - | - |
| CHANGE OF MAILING ADDRESS | 2015-01-07 | 13641 METROPOLIS AVENUE #102, FORT MYERS, FL 33912 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-07 | 13641 METROPOLIS AVE, STE 102, FORT MYERS, FL 33912 | - |
| LC AMENDMENT | 2014-02-27 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-02-27 | 13641 METROPOLIS AVENUE #102, FORT MYERS, FL 33912 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-14 |
| ANNUAL REPORT | 2016-01-23 |
| ANNUAL REPORT | 2015-01-07 |
| LC Amendment | 2014-02-27 |
| Florida Limited Liability | 2014-02-10 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
