Healthcare Provider Details

I. General information

NPI: 1568041549
Provider Name (Legal Business Name): ACELYNE SUMMERSON GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD
AVENTURA FL
33180-1407
US

IV. Provider business mailing address

7230 FAIRWAY DR APT F11
MIAMI LAKES FL
33014-6963
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-7000
  • Fax:
Mailing address:
  • Phone: 305-557-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME173724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: