Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Stephen Harris, PA

Individual provider Physician Assistant · NPI 1528762879

Shane Stephen Harris, PA is a Physician Assistant in Libertyville, Illinois. Qualified in 2023, 3 years ago. Practices with Ganesha Institute of Neurology and Psychiatry SC, a 25-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Illinois and Wisconsin.

Years since qualifying
3
Licensed in
IL, WI
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone: (847) 816-6335
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9555 76th St Fl 2, Pleasant Prairie, WI 53158-1984 — (262) 577-8300

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.009911 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 8293 (WI)

Record details

NPI number1528762879
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedMarch 29, 2023
Last updated in NPPESSeptember 18, 2025
Certification dateSeptember 18, 2025
Mailing address1860 W Winchester Rd Ste 106, Libertyville, IL 60048-5312

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Ganesha Institute Of Neurology And Psychiatry Sc — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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