=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053538819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANISHA GODBOLE AU.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 369 W 1ST ST SUITE 406
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45402-3095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-222-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3170 KETTERING BLVD BLDG B2ND
-----------------------------------------------------
City | MORAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45439-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-991-3188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | A-01433
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------