| Entity Name: | SUJATA S. BALULAD, MD., PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Oct 2018 (6 years ago) |
| Document Number: | P18000083356 |
| FEI/EIN Number | 83-2146795 |
| Address: | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL, 32937, US |
| Mail Address: | 10311 Hawks Gully Court, Wildwood, FL, 34484, US |
| ZIP code: | 32937 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154897130 | 2018-10-17 | 2023-07-04 | 1095 HIGHWAY A1A APT 2201, SATELLITE BEACH, FL, 32937, US | 33041 PROFESSIONAL DR STE 101, LEESBURG, FL, 347883761, US | |||||||||||||||
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| Phone | +1 352-478-0010 |
| Fax | 9495774163 |
Authorized person
| Name | DR. SUJATA SHANKARAPPA BALULAD |
| Role | PHYSICIAN |
| Phone | 5185731552 |
Taxonomy
| Taxonomy Code | 207RC0001X - Clinical Cardiac Electrophysiology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BALULAD SUJATA A | Agent | 1095 HIGHWAY A1A, SATELLITE BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| BALULAD SUJATA S | Director | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| BALULAD SUJATA S | President | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| BALULAD SUJATA S | Treasurer | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| BALULAD SUJATA S | Secretary | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-03-27 | 1095 HIGHWAY A1A, UNIT 2201, SATELLITE BEACH, FL 32937 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-25 |
| ANNUAL REPORT | 2023-04-15 |
| ANNUAL REPORT | 2022-03-27 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-02-09 |
| Domestic Profit | 2018-10-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
