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 1:2700 PROSPERITY AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4321
Mailing Address - Country:US
Mailing Address - Phone:703-698-2431
Mailing Address - Fax:571-665-6878
Practice Address - Street 1:2700 PROSPERITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4321
Practice Address - Country:US
Practice Address - Phone:703-698-2431
Practice Address - Fax:571-665-6878
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2025-05-14
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