| Entity Name: | VIP NEUROLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Sep 2014 (10 years ago) |
| Document Number: | L14000145024 |
| FEI/EIN Number | 47-1862717 |
| Address: | 6105 N. WICKHAM RD., 1682, MELBOURNE, FL, 32941 |
| Mail Address: | 1387 Dorset Pl, MELBOURNE, FL, 32940, US |
| ZIP code: | 32941 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659774685 | 2014-10-05 | 2014-12-19 | 6105 N WICKHAM RD, #411682, MELBOURNE, FL, 329417001, US | 300 FORTENBERRY RD, MERRITT ISLAND, FL, 329523621, US | |||||||||||||||||||||||||
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| Phone | +1 321-325-1155 |
| Fax | 3213730055 |
Authorized person
| Name | NIKOLAY STAMBOLIYSKI |
| Role | AUTHORIZED PERSON |
| Phone | 3217510041 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME81256 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261465100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STAMBOLIYSKI NIKOLAY | Agent | 6105 N. WICKHAM RD., MELBOURNE, FL, 32941 |
| Name | Role | Address |
|---|---|---|
| STAMBOLIYSKA MAYA MD | Manager | 6105 N. WICKHAM RD., MELBOURNE, FL, 32941 |
| Name | Role | Address |
|---|---|---|
| STAMBOLIYSKI NIKOLAY MD | Authorized Person | 6105 N. WICKHAM RD., MELBOURNE, FL, 32941 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-02-04 | 6105 N. WICKHAM RD., 1682, MELBOURNE, FL 32941 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-03-06 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-03-03 |
| ANNUAL REPORT | 2016-04-03 |
| ANNUAL REPORT | 2015-03-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
