| Entity Name: | EVOLUTION PSYCHIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Nov 2021 (3 years ago) |
| Document Number: | L21000475667 |
| FEI/EIN Number | 87-3432826 |
| Address: | 1732 NE 26th Street, Wilton Manors, FL 33305 |
| Mail Address: | 1732 NE 26th Street, Wilton Manors, FL 33305 |
| ZIP code: | 33305 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679225825 | 2022-01-19 | 2022-01-19 | 3012 SAN CLARA DR # 18C, DELRAY BEACH, FL, 334455429, US | 915 MIDDLE RIVER DR STE 103C, FORT LAUDERDALE, FL, 333043559, US | |||||||||||||
|
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| Phone | +1 774-365-9192 |
Authorized person
| Name | SHANNAN VICTORINO |
| Role | OWNER |
| Phone | 7743659192 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Victorino , Shannan Marie | Agent | 299 NW 52ND TERRACE, Boca Raton, FL 33487 |
| Name | Role | Address |
|---|---|---|
| Victorino, Shannan Marie | Managing member | 299 NW 52ND TERRACE, Boca Raton, FL 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-04 | 1732 NE 26th Street, Wilton Manors, FL 33305 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-04 | 1732 NE 26th Street, Wilton Manors, FL 33305 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-27 | 299 NW 52ND TERRACE, Boca Raton, FL 33487 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-26 | Victorino , Shannan Marie | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-06 |
| AMENDED ANNUAL REPORT | 2024-11-28 |
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-01-26 |
| Florida Limited Liability | 2021-11-03 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
