| Doctor Name: | MS. JAMIE KOUMOUNDOUROS |
| NPI Number: | 1164726055 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | |
| Business Practice Address: | 1351 Route 55 Ste 200 Lagrangeville, NY - 125405128 |
| Business Phone Number: | 8454759640 |
| Business Fax Number: | |
| Mailing Address: | 2840 Chessington Dr, NEW LENOX |
| State: | IL |
| Postal Code: | 604512889 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/06/2011 |
| NPI Last Update Date: | 01/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |