Healthcare Provider Details

I. General information

NPI: 1518874635
Provider Name (Legal Business Name): PETER SANTIAGO DEMOYA APSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E NEW CIRCLE RD STE 190
LEXINGTON KY
40509-1044
US

IV. Provider business mailing address

1555 E NEW CIRCLE RD STE 190
LEXINGTON KY
40509-1044
US

V. Phone/Fax

Practice location:
  • Phone: 859-329-1181
  • Fax: 859-407-1186
Mailing address:
  • Phone: 859-329-1181
  • Fax: 859-407-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1222556
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: