| Entity Name: | W. SAND LAKE MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 01 Oct 2015 (9 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L15000167675 |
| FEI/EIN Number | 47-5334432 |
| Address: | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 |
| Mail Address: | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 |
| ZIP code: | 33461 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558726257 | 2015-12-22 | 2015-12-22 | 2328 10TH AVE N STE 302, LAKE WORTH, FL, 334616612, US | 2431 SAND LAKE RD, ORLANDO, FL, 328097641, US | |||||||||||||
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| Phone | +1 855-876-8648 |
Authorized person
| Name | NICK MATTEO |
| Role | CFO |
| Phone | 5613184430 |
Taxonomy
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHIEFFALLO, CARA | Agent | NASON YEAGER ETAL, 3001 PGA BLVD., #305, PALM BEACH GARDENS, FL 33410 |
| Name | Role | Address |
|---|---|---|
| DORAN, TIMOTHY | MANAGER | 2328 10TH AVE N, STE 301 LAKE WORTH, FL 33461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-10-01 | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 | No data |
| CHANGE OF MAILING ADDRESS | 2025-10-01 | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-01 | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-01 | 2328 10TH AVE N STE 301, LAKE WORTH, FL 33461 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-09 | CHIEFFALLO, CARA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-09 | NASON YEAGER ETAL, 3001 PGA BLVD., #305, PALM BEACH GARDENS, FL 33410 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-09 |
| ANNUAL REPORT | 2017-01-27 |
| ANNUAL REPORT | 2016-03-29 |
| Florida Limited Liability | 2015-10-01 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
