Healthcare Provider Details

I. General information

NPI: 1104351980
Provider Name (Legal Business Name): DEREK LEADERER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PL STE 402
CELEBRATION FL
34747-5436
US

IV. Provider business mailing address

410 CELEBRATION PL STE 402
CELEBRATION FL
34747-5436
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4080
  • Fax: 407-303-7255
Mailing address:
  • Phone: 407-303-4080
  • Fax: 407-303-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME174788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: