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

Nicole Sazonov

Individual provider Family Medicine Physician · NPI 1386364768

Nicole Sazonov is a Physician Assistant in Portland, Oregon. Qualified in 2023, 3 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
3
Licensed in
OR
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

8329 SW Beaverton Hillsdale Hwy
Portland, OR 97225-2215
Phone: (503) 414-5160
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA217770 (OR)
Family Medicine Physician Taxonomy 207Q00000X · Licence PA217770 (OR)

Record details

NPI number1386364768
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 29, 2022
Last updated in NPPESDecember 13, 2023
Certification dateDecember 13, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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