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1538427802
VICTORIA ELENA SHACK
PORT JEFFERSON, NY
NPI
1538427802
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: NY 056759-1)
Enumeration Date
2012-04-24
Last Update Date
2013-09-06
Business Address
-- VICTORIA ELENA SHACK DDS
150 N COUNTRY RD APT A10
PORT JEFFERSON, NY 11777-2154
Phone number: 917-324-7927
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Mailing Address
-- VICTORIA ELENA SHACK DDS
150 N COUNTRY RD APT A10
PORT JEFFERSON, NY 11777-2154
Phone number: 917-324-7927
Copy
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