Provider Demographics
NPI:1124988910
Name:BILALISSA, ODALOU
Entity type:Individual
Prefix:
First Name:ODALOU
Middle Name:
Last Name:BILALISSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 FELTON AVE
Mailing Address - Street 2:216 FELTON AVE
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2105
Mailing Address - Country:US
Mailing Address - Phone:267-577-0828
Mailing Address - Fax:
Practice Address - Street 1:216 FELTON AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-2105
Practice Address - Country:US
Practice Address - Phone:267-577-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA78793601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide