Shirley A Mirisciotti, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.002363RX Issued in OH

Practice address

75 Sylvania Dr
Beavercreek, OH 45440-3237

Phone

(937) 320-5050

Fax

(937) 320-5060

NPI assigned

Apr 16, 2007

Last updated

Aug 25, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1902021975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SYLVANIA DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454403237",
            "telephone_number": "937-320-5050",
            "fax_number": "937-320-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SYLVANIA DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454403237",
            "telephone_number": "937-320-5050",
            "fax_number": "937-320-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRISCIOTTI",
        "first_name": "SHIRLEY",
        "middle_name": "A",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002363",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002363RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147626",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minds Unltd LLC
• Laura Michele Minik, PA-C
• Ryan A Mink
• Rachael Hope Minnich
• Jamie Minnish, RBT
• Jeffrey D Mischnick, PT
• Jonathan P. Moayyad, M.D.
• Mobility Fit Physical Therapy LLC
• Krima Modi
• Phyllis Mogielski Watson, LPCC

• Physician Assistant in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.