MEDICARE: SHANIAH GABRIELLE LIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209034086	IL

General Provider Information

NPI Number	:	1710668868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIAH GABRIELLE LIM

Provider Business Mailing Address
First Line	:	2555 BANGERT LN
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5927
Country	:	US
Telephone Number	:	630-386-7240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1653 W CONGRESS PKWY # 12
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3833
Country	:	US
Telephone Number	:	312-942-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	01/06/2026

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