| Entity Name: | SHANNON TAYLOR SPEECH LANGUAGE PATHOLOGIST, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Aug 2010 (14 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: | P10000069719 |
| FEI/EIN Number | 900617271 |
| Address: | 2955 SW COASTAL TERRACE, PORT ST. LUCIE, FL, 34953-6947, US |
| Mail Address: | 2955 SW COASTAL TERRACE, PORT ST. LUCIE, FL, 34953-6947, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346652872 | 2014-06-02 | 2014-06-02 | 2456 SW INDEPENDENCE RD, PORT ST LUCIE, FL, 349532415, US | 2456 SW INDEPENDENCE RD, PORT ST LUCIE, FL, 349532415, US | |||||||||||||||||||||||||
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| Phone | +1 772-528-1842 |
| Fax | 8888995320 |
Authorized person
| Name | MS. SHANNON E TAYLOR |
| Role | OWNER |
| Phone | 7725281842 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA7003 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 892221700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TAYLOR n/k/a CARVELLSHANNON | Agent | 2456 SW INDEPENDENCE ROAD, PORT SAINT LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| TAYLOR SHANNON | President | 2955 SW COASTAL TERRACE, PORT ST. LUCIE, FL, 349536947 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-11-08 | 2955 SW COASTAL TERRACE, PORT ST. LUCIE, FL 34953-6947 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-11-08 | 2955 SW COASTAL TERRACE, PORT ST. LUCIE, FL 34953-6947 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-26 | 2456 SW INDEPENDENCE ROAD, PORT SAINT LUCIE, FL 34953 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-26 | TAYLOR n/k/a CARVELLI, SHANNON | No data |
| PENDING REINSTATEMENT | 2013-01-31 | No data | No data |
| REINSTATEMENT | 2013-01-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-15 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-16 |
| REINSTATEMENT | 2013-01-31 |
| Domestic Profit | 2010-08-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
