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TAMPA BAY DIABETES, THYROID & ENDOCRINOLOGY CENTER PA

Company Details

Entity Name: TAMPA BAY DIABETES, THYROID & ENDOCRINOLOGY CENTER PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 15 Aug 2013 (11 years ago)
Last Event: AMENDMENT
Event Date Filed: 10 Nov 2014 (10 years ago)
Document Number: P13000068039
FEI/EIN Number 46-3463495
Address: 5775 5TH AVENUE N, ST PETERSBURG, FL, 33710-7103, US
Mail Address: 5775 5TH AVENUE N, ST PETERSBURG, FL, 33710-7103, US
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1194113340 2014-12-22 2014-12-22 5775 5TH AVE N, ST PETERSBURG, FL, 337107103, US 5775 5TH AVE N, ST PETERSBURG, FL, 337107103, US

Contacts
Phone +1 727-345-5222
Fax 7273454066

Authorized person
Name AJAY VARANASI
Role PRESIDENT
Phone 7273455222

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME108742
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 401(K) P/S PLAN 2022 463463495 2023-04-28 TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3217739516
Plan sponsor’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 463463495
Plan administrator’s name TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA
Plan administrator’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710
Administrator’s telephone number 3217739516

Signature of
Role Plan administrator
Date 2023-04-28
Name of individual signing MICHAEL GEMMELL
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 401(K) P/S PLAN 2021 463463495 2022-07-06 TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3217739516
Plan sponsor’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 463463495
Plan administrator’s name TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA
Plan administrator’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710
Administrator’s telephone number 3217739516

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing MICHAEL GEMMELL
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 401(K) P/S PLAN 2020 463463495 2021-06-07 TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3217739516
Plan sponsor’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 463463495
Plan administrator’s name TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA
Plan administrator’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710
Administrator’s telephone number 3217739516

Signature of
Role Plan administrator
Date 2021-06-07
Name of individual signing MICHAEL GEMMELL
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 401(K) P/S PLAN 2019 463463495 2020-05-04 TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3217739516
Plan sponsor’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 463463495
Plan administrator’s name TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA
Plan administrator’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710
Administrator’s telephone number 3217739516

Signature of
Role Plan administrator
Date 2020-05-04
Name of individual signing MICHAEL GEMMELL
Valid signature Filed with authorized/valid electronic signature
TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 401(K) P/S PLAN 2018 463463495 2019-04-16 TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3217739516
Plan sponsor’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710

Plan administrator’s name and address
Administrator’s EIN 463463495
Plan administrator’s name TAMPA BAY DIABETES THYROID ENDOCRINOLOGY CENTER PA
Plan administrator’s address 5775 5TH AVE N, SAINT PETERSBURG, FL, 33710
Administrator’s telephone number 3217739516

Signature of
Role Plan administrator
Date 2019-04-16
Name of individual signing MICHAEL GEMMELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
VARANASI AJAY Agent 5775 5TH AVENUE N, ST PETERSBURG, FL, 337107103

President

Name Role Address
VARANASI AJAY MD President 4903 W BAY WAY DRIVE, TAMPA, FL, 33629

Secretary

Name Role Address
VARANASI AJAY MD Secretary 4903 W BAY WAY DRIVE, TAMPA, FL, 33629

Treasurer

Name Role Address
VARANASI AJAY MD Treasurer 4903 W BAY WAY DRIVE, TAMPA, FL, 33629

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2021-03-10 VARANASI, AJAY No data
REGISTERED AGENT ADDRESS CHANGED 2021-03-10 5775 5TH AVENUE N, ST PETERSBURG, FL 33710-7103 No data
AMENDMENT 2014-11-10 No data No data
CHANGE OF PRINCIPAL ADDRESS 2014-11-10 5775 5TH AVENUE N, ST PETERSBURG, FL 33710-7103 No data
CHANGE OF MAILING ADDRESS 2014-11-10 5775 5TH AVENUE N, ST PETERSBURG, FL 33710-7103 No data

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-04-29
ANNUAL REPORT 2022-04-30
ANNUAL REPORT 2021-03-10
ANNUAL REPORT 2020-03-11
ANNUAL REPORT 2019-04-08
ANNUAL REPORT 2018-03-13
ANNUAL REPORT 2017-03-22
ANNUAL REPORT 2016-04-03
ANNUAL REPORT 2015-04-30

Related by officers

VARANASI AJAY MD

ENDOCRINOLOGY ASSOCIATES OF TAMPA BAY PA

VARANASI AJAY

VARANASI LLC MYNDARO HEALTH LLC

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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