Healthcare Provider Details

I. General information

NPI: 1396791877
Provider Name (Legal Business Name): ODETT R STANLEY-BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 ROLLING ACRES RD STE 4
LADY LAKE FL
32159-5026
US

IV. Provider business mailing address

918 ROLLING ACRES RD STE 4
LADY LAKE FL
32159-5026
US

V. Phone/Fax

Practice location:
  • Phone: 352-831-7675
  • Fax: 352-707-3023
Mailing address:
  • Phone: 352-831-7675
  • Fax: 352-707-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME59781
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: