Healthcare Provider Details

I. General information

NPI: 1396801361
Provider Name (Legal Business Name): ODALYS BRITO MD & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

PO BOX 1317
ST AUGUSTINE FL
32085-1317
US

V. Phone/Fax

Practice location:
  • Phone: 904-808-7362
  • Fax: 904-808-7363
Mailing address:
  • Phone: 904-808-7362
  • Fax: 904-808-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME94487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME94487
License Number StateFL

VIII. Authorized Official

Name: DR. ODALYS BRITO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-808-7362