Healthcare Provider Details

I. General information

NPI: 1225070659
Provider Name (Legal Business Name): SHANIN LYNN GOODALL-DIEHL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 10TH ST E STE B
PALMETTO FL
34221-4161
US

IV. Provider business mailing address

1301 10TH ST E STE B
PALMETTO FL
34221-4161
US

V. Phone/Fax

Practice location:
  • Phone: 941-722-0043
  • Fax:
Mailing address:
  • Phone: 941-722-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: