Diana Sofia Glaccum-Gavagni, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME105239 Issued in FL

Practice address

900 SW 196TH Ave
Pembroke Pines, FL 33029-1329

Phone

(954) 546-2707

Fax

(305) 355-7195

NPI assigned

May 29, 2007

Last updated

Apr 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Diana Sofia Glaccum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mind, Body & Soul Psychiatry, P.a.

  • Psychiatry Physician
  • Lake Worth, FL
  • NPI 1740045004
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1801097001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20984 UPTOWN AVE APT 105",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334286579",
            "telephone_number": "954-546-2707",
            "fax_number": "954-820-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SW 196TH AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330291329",
            "telephone_number": "954-546-2707",
            "fax_number": "305-355-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLACCUM-GAVAGNI",
        "first_name": "DIANA",
        "middle_name": "SOFIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME105239",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME105239",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001754800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "GLACCUM",
            "middle_name": "SOFIA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Javier Giraldo, RDN, LDN
• Vanessa Giraldo, APRN
• Caroline Girello, L.AC
• Ganesh Giri
• Blake Giroux
• Alexis Leigh Glaser, D.M.D
• Robert Aldworth Glass, M.D.
• Glen Siegel P.a.
• Arthur Glick, APRN
• Glicksman & Mars Dental.LC

• Psychiatry Physician in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.