| Entity Name: | SANJAY SASTRY MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Jun 2019 (6 years ago) |
| Document Number: | P19000048266 |
| FEI/EIN Number | 35-2666796 |
| Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168, US |
| Mail Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL, 32168, US |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891315859 | 2020-04-20 | 2020-04-20 | 612 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687327, US | 612 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687327, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 386-423-5500 |
Authorized person
| Name | SANJAY SASTRY |
| Role | OWNER |
| Phone | 4072803630 |
Taxonomy
| Taxonomy Code | 207LA0401X - Addiction Medicine (Anesthesiology) Physician |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| MADISON GREY STREET LLC | Agent |
| Name | Role | Address |
|---|---|---|
| SASTRY SANJAY | President | 1640 EDLESHEARAN, LAKE MARY, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000137016 | ABSOLUTE PAIN INSTITUTE | ACTIVE | 2020-10-22 | 2025-12-31 | No data | 612 PALMETTO ST, NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-30 | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-30 | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 5500 MIITARY TRAIL, 22295, JUPITER, FL 33458 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-30 |
| Domestic Profit | 2019-06-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
