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

Mrs. Fawn Shelley Mumbulo, FNP-C

Individual provider Family Nurse Practitioner · NPI 1720493984

Mrs. Fawn Shelley Mumbulo, FNP-C is a Nurse Practitioner in Cooperstown, New York. Qualified in 2014, 12 years ago. Practices with Mary Imogene Bassett Hospital, a 779-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
12
Licensed in
NY
In the registry since
2014
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

1 Atwell Rd
Cooperstown, NY 13326-1394
Phone: (607) 547-3480
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 20 Chapel St, Sherburne, NY 13460-9753 — (607) 674-2445

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence F338835-1 (NY)

Record details

NPI number1720493984
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedJune 26, 2014
Last updated in NPPESApril 3, 2026
Certification dateApril 3, 2026

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Mary Imogene Bassett Hospital — 779 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Cooperstown