| Entity Name: | ROGER SHEA, M.D., INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Sep 1995 (29 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Oct 2019 (5 years ago) |
| Document Number: | P95000070754 |
| FEI/EIN Number | 59-3341054 |
| Address: | 5432 BEE RIDGE ROAD, STE #140, SARASOTA, FL 34233 |
| Mail Address: | 5432 BEE RIDGE ROAD, STE #140, SARASOTA, FL 34233 |
| ZIP code: | 34233 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861406019 | 2006-07-27 | 2020-09-17 | 5432 BEE RIDGE RD, STE #140, SARASOTA, FL, 342331514, US | 5432 BEE RIDGE RD, STE #140, SARASOTA, FL, 342331514, US | |||||||||||||||||||||||||
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| Phone | +1 941-371-2244 |
| Fax | 9413711144 |
Authorized person
| Name | DR. ROGER M SHEA |
| Role | PRESIDENT |
| Phone | 9413712244 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0065243 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 379122000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHEA, JOHN J | Agent | 1776 RINGLING BLVD, SARASOTA, FL 34236 |
| Name | Role | Address |
|---|---|---|
| SHEA, ROGER M.D. | Director | 5432 BEE RIDGE ROAD - SUITE #140, SARASOTA, FL 34233 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000032225 | SHEA ENT CLINIC | EXPIRED | 2013-04-03 | 2018-12-31 | No data | 5432 BEE RIDGE ROAD, SUITE 140, SARASOTA, FL, 34233 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-10-16 | SHEA, JOHN J | No data |
| REINSTATEMENT | 2019-10-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-25 | 1776 RINGLING BLVD, SARASOTA, FL 34236 | No data |
| AMENDMENT AND NAME CHANGE | 2007-12-20 | ROGER SHEA, M.D., INC. | No data |
| CANCEL ADM DISS/REV | 2007-01-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| CANCEL ADM DISS/REV | 2004-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-04-23 | 5432 BEE RIDGE ROAD, STE #140, SARASOTA, FL 34233 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-04-22 |
| REINSTATEMENT | 2019-10-16 |
| ANNUAL REPORT | 2018-03-20 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
