Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derrek Giansiracusa

Individual provider Dermatology Physician · NPI 1154023737

Derrek Giansiracusa is a Dermatology in Glendale, Arizona. Graduated from Lake Erie College of Osteopathic Medicine, Bradenton in 2023, 3 years ago. Practices with Omni Dermatology Incorporated, a 13-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
3
Trained at
Lake Erie College of Osteopathic Medicine, Bradenton
Licensed in
AZ
In the registry since
2023
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Practice location Address checks out

11851 N 51st Ave Ste E130
Glendale, AZ 85304-2843
Phone: (623) 299-9540
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 011498 (AZ)

Record details

NPI number1154023737
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 20, 2023
Last updated in NPPESMarch 25, 2025
Certification dateMarch 25, 2025
Mailing address11851 N 51st Ave Ste E130, Glendale, AZ 85304-2843

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolLAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, BRADENTON
Graduated 2023 (3 years in practice)
Group practice Omni Dermatology Incorporated — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Glendale