Provider Demographics
NPI:1659666139
Name:MCCALLA, CHERYL-LYNNE DEIDRE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL-LYNNE
Middle Name:DEIDRE
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHERYL-LYNNE
Other - Middle Name:DEIDRE
Other - Last Name:ARCHIBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1141 ELDEN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5572
Mailing Address - Country:US
Mailing Address - Phone:703-443-2000
Mailing Address - Fax:
Practice Address - Street 1:1141 ELDEN ST STE 300
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5572
Practice Address - Country:US
Practice Address - Phone:703-443-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203396208D00000X, 207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine