| Entity Name: | SHAYA MEDICAL P.C. INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 21 Apr 2015 (10 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P15000036330 |
| FEI/EIN Number | 47-3782811 |
| Address: | 4235 sunbeam rd., JACKSONVILLE, FL 32257 |
| Mail Address: | 4235 sunbeam rd., JACKSONVILLE, FL 32257 |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891173852 | 2015-05-11 | 2019-09-25 | 4235 SUNBEAM RD, JACKSONVILLE, FL, 322576013, US | 4235 SUNBEAM RD, JACKSONVILLE, FL, 322576013, US | |||||||||||||||
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| Phone | +1 904-322-8555 |
| Fax | 9043228578 |
Authorized person
| Name | DR. WISSAM SHAYA |
| Role | PRESIDENT |
| Phone | 9043228555 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHAYA MEDICAL 401K PLAN | 2019 | 473782811 | 2020-10-26 | SHAYA MEDICAL | 12 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2020-10-26 |
| Name of individual signing | WISSAM SHAYA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5862439404 |
| Plan sponsor’s address | 4235 SUNBEAM RD, JACKSONVILLE, FL, 32257 |
Signature of
| Role | Plan administrator |
| Date | 2019-06-14 |
| Name of individual signing | WISSAM SHAYA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5862439404 |
| Plan sponsor’s address | 4235 SUNBEAM RD, JACKSONVILLE, FL, 32257 |
Signature of
| Role | Plan administrator |
| Date | 2018-06-14 |
| Name of individual signing | WISSAM SHAYA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SHAYA, WISSAM, Dr. | Agent | 4235 sunbeam rd., JACKSONVILLE, FL 32257 |
| Name | Role | Address |
|---|---|---|
| SHAYA, WISSAM, Dr. | President | 4235 sunbeam rd., JACKSONVILLE, FL 32257 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000097845 | SMART CHOICE MEDICAL | EXPIRED | 2019-09-06 | 2024-12-31 | No data | 4235 SUNBEAM, JACKSONVILLE, FL, 32257 |
| G15000097357 | SMART CHOICE FAMILY MEDICINE | EXPIRED | 2015-09-22 | 2020-12-31 | No data | 1907 ATLANTIC BLVD, JACKSONVILLE, FL, 32207 |
| G15000097358 | SMART CHOICE URGENT CARE | ACTIVE | 2015-09-22 | 2025-12-31 | No data | 4235 SUN BEAM, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-02-29 | 4235 sunbeam rd., JACKSONVILLE, FL 32257 | No data |
| CHANGE OF MAILING ADDRESS | 2016-02-29 | 4235 sunbeam rd., JACKSONVILLE, FL 32257 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-29 | SHAYA, WISSAM, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-29 | 4235 sunbeam rd., JACKSONVILLE, FL 32257 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-01-04 |
| ANNUAL REPORT | 2018-02-02 |
| ANNUAL REPORT | 2017-01-26 |
| ANNUAL REPORT | 2016-02-29 |
| Domestic Profit | 2015-04-21 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
