Victoria Elena Shack, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

056759-1 Issued in NY

Practice address

31 Fairway Dr
Rocky Point, NY 11778-9433

Phone

(631) 928-7500

Fax

(631) 928-7501

NPI assigned

Apr 24, 2012

Last updated

Apr 1, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Fork Family Dentistry PC

  • General Practice Dentistry
  • East Quogue, NY
  • NPI 1720766868
  NPD Authorized official
• Victoria E. Shack, DDS, PC

  • Dentist
  • Port Jefferson Station, NY
  • NPI 1366896466
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1538427802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 FAIRWAY DR",
            "city": "ROCKY POINT",
            "state": "NY",
            "postal_code": "117789433",
            "telephone_number": "631-928-7500",
            "fax_number": "631-928-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 FAIRWAY DR",
            "city": "ROCKY POINT",
            "state": "NY",
            "postal_code": "117789433",
            "telephone_number": "631-928-7500",
            "fax_number": "631-928-7501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "426 Montauk Hwy",
            "address_purpose": "LOCATION",
            "city": "East Quogue",
            "state": "NY",
            "postal_code": "119423952",
            "country_code": "US",
            "telephone_number": "631-653-4479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACK",
        "first_name": "VICTORIA",
        "middle_name": "ELENA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-24",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "056759-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Ann Schmidt, PT
• Rebecca Nicole Schnettler, RN, IBCLC
• John M Schwartzberg, D.O.
• Shannon Marie Scofield, LPN
• Jill M Setaro, ACNS-BC
• Maureen T. Shea, PH.D.
• Scott C Sherman, MD
• Sherrie Glasser Physical Therapy John Douglas Physical Therapy (Metro Comprehensive Physical & Aquatic Therapy)
• Carol Anne Sherwood, LCSW
• Su Ah Shin

• General Practice Dentistry in Rocky Point, NY
• Providers in Rocky Point, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.