Healthcare Provider Details

I. General information

NPI: 1851286462
Provider Name (Legal Business Name): ASYA N. MIRAKOVA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MAYFIELD RD STE 105
LYNDHURST OH
44124-2608
US

IV. Provider business mailing address

3040 DARIEN LN
TWINSBURG OH
44087-3236
US

V. Phone/Fax

Practice location:
  • Phone: 216-691-2484
  • Fax: 216-691-2482
Mailing address:
  • Phone: 216-502-7427
  • Fax: 216-249-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: