Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Hillsborough
    4. ›
  4. 33511
    5. ›
  5. VALRICO MEDICAL CLINIC PA

VALRICO MEDICAL CLINIC PA

Company Details

Entity Name: VALRICO MEDICAL CLINIC PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 18 May 2004 (21 years ago)
Date of dissolution: 18 May 2022 (3 years ago)
Last Event: CONVERSION
Event Date Filed: 18 May 2022 (3 years ago)
Document Number: P04000079543
FEI/EIN Number 270092886
Address: 1111 Lithia Pinecrest Rd, Brandon, FL, 33511, US
Mail Address: 1111 Lithia Pinecrest Rd, Brandon, FL, 33511, US
ZIP code: 33511
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083801609 2007-09-27 2007-09-27 3119 LITHIA PINECREST RD, VALRICO, FL, 335965632, US 3119 LITHIA PINECREST RD, VALRICO, FL, 335965632, US

Contacts
Phone +1 813-643-3242

Authorized person
Name MR. SYDNEY SHAW
Role OFFICE MANAGER
Phone 8136433242

Taxonomy
Taxonomy Code 173000000X - Legal Medicine
License Number ME83318
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS GROUP NUMBER
Number 13136
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2022 270092886 2023-02-01 VALRICO MEDICAL CLINIC PA 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2023-02-01
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-01
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2021 270092886 2022-05-25 VALRICO MEDICAL CLINIC PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2022-05-25
Name of individual signing SYNDEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-25
Name of individual signing SYNDEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2020 270092886 2021-09-29 VALRICO MEDICAL CLINIC PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2021-09-27
Name of individual signing SYNDEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-27
Name of individual signing SYNDEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2019 270092886 2020-06-03 VALRICO MEDICAL CLINIC PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2020-06-03
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-03
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2018 270092886 2019-09-30 VALRICO MEDICAL CLINIC PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2019-09-30
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-09-30
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2017 270092886 2018-10-10 VALRICO MEDICAL CLINIC PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 1111 LITHIA PINECREST ROAD, BRANDON, FL, 33511

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-09
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2016 270092886 2017-09-19 VALRICO MEDICAL CLINIC PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 3119 LITHIA PINECREST ROAD, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2017-09-18
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-18
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2015 270092886 2016-10-17 VALRICO MEDICAL CLINIC PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 3119 LITHIA PINECREST ROAD, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2014 270092886 2015-09-25 VALRICO MEDICAL CLINIC PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 3119 LITHIA PINECREST ROAD, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2015-09-24
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-24
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
VALRICO MEDICAL CLINIC PA PROFIT SHARING PLAN 2013 270092886 2014-07-23 VALRICO MEDICAL CLINIC PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8136433242
Plan sponsor’s address 3119 LITHIA PINECREST ROAD, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-23
Name of individual signing SYDNEY SHAW
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Shaw Sydney Agent 1111 Lithia Pinecrest Rd, Brandon, FL, 33511

President

Name Role Address
SHAW IZABELA President 1111 LITHIA PINECREST ROAD, Brandon, FL, 33511

Director

Name Role Address
SHAW IZABELA Director 1111 LITHIA PINECREST ROAD, Brandon, FL, 33511

Events

Event Type Filed Date Value Description
CONVERSION 2022-05-18 No data CONVERSION MEMBER. RESULTING CORPORATION WAS L22000211416. CONVERSION NUMBER 700000226597
CHANGE OF PRINCIPAL ADDRESS 2020-03-24 1111 Lithia Pinecrest Rd, Brandon, FL 33511 No data
CHANGE OF MAILING ADDRESS 2020-03-24 1111 Lithia Pinecrest Rd, Brandon, FL 33511 No data
REGISTERED AGENT ADDRESS CHANGED 2019-02-06 1111 Lithia Pinecrest Rd, Brandon, FL 33511 No data
REGISTERED AGENT NAME CHANGED 2013-04-15 Shaw, Sydney No data
REINSTATEMENT 2010-09-27 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data

Documents

Name Date
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-02-03
ANNUAL REPORT 2020-03-24
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-01-24
ANNUAL REPORT 2017-01-06
ANNUAL REPORT 2016-03-05
ANNUAL REPORT 2015-02-17
ANNUAL REPORT 2014-03-06
ANNUAL REPORT 2013-04-15

Related by officers

SHAW IZABELA

DOCTORS CARE PLUS PA SIBR, INC SIBREQ, LLC VALRICO MEDICAL HOLDINGS, INC. SIBR PROPERTIES LLC

Shaw Sydney

DOCTORS CARE PLUS PA

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated