| Entity Name: | BLUE WAVE MEDICAL ASSOCIATES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 May 2023 (2 years ago) |
| Document Number: | L23000255473 |
| FEI/EIN Number | 93-1564594 |
| Address: | 1822 DREW STREET, CLEARWATER, FL 33765 |
| Mail Address: | 28 CAVALRY RD, WESTPORT, CT 06880 |
| ZIP code: | 33765 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760167233 | 2023-06-21 | 2023-06-21 | 28 CAVALRY RD, WESTPORT, CT, 068801401, US | 1822 DREW ST, CLEARWATER, FL, 337652921, US | |||||||||||||||||||
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| Phone | +1 917-576-7624 |
| Fax | 2032861282 |
Authorized person
| Name | DR. AUDREY Z PAUL |
| Role | OWNER |
| Phone | 9175767624 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 2081P0301X - Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| PAUL, AUDREY | Agent | 1822 DREW STREET, CLEARWATER, FL 33765 |
| Name | Role | Address |
|---|---|---|
| PAUL, AUDREY, DR | Manager | 28 CAVALRY RD, WESTPORT, CT 06880 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000068184 | BLUE WAVE PEDIATRICS AND WALK-IN | ACTIVE | 2024-05-30 | 2029-12-31 | No data | 1822 DREW STREET SUITE 101, CLEARWATER, FL, 33765 |
| G23000068974 | BLUE WAVE CONCUSSION CENTER | ACTIVE | 2023-06-06 | 2028-12-31 | No data | 1822 DREW STREET, CLEARWATER, FL, 33765 |
| G23000009164 | BLUE WAVE PEDIATRICS | ACTIVE | 2023-06-02 | 2028-12-31 | No data | 1822 DREW STREET, CLEARWATER, FL, 33765 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-22 |
| Florida Limited Liability | 2023-05-24 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
