Prep the shrimp. Pat shrimp dry with paper towels.
Season both sides with salt and pepper. If using zucchini noodles, spiralize and set them on a towel to absorb excess moisture.
Sear the shrimp. Heat olive oil and 1 tablespoon butter in a large skillet over medium-high. Add shrimp in a single layer and cook 1–2 minutes per side until just opaque.
Transfer to a plate and set aside.
Sauté the aromatics. Reduce heat to medium. Add remaining 1 tablespoon butter and the minced garlic. Cook 30–45 seconds until fragrant, stirring often.
Avoid browning the garlic.
Build the sauce. Pour in heavy cream and stir, scraping up any browned bits. Add cream cheese cubes and whisk until melted and smooth, about 2–3 minutes.
Add the Parmesan. Sprinkle in Parmesan gradually, whisking until the sauce is silky and slightly thickened. If using red pepper flakes, stir them in now.
Simmer gently for 2–3 minutes; don’t let it boil hard.
Finish with lemon and seasoning. Stir in lemon juice. Taste and adjust with salt and pepper. The lemon brightens the sauce and keeps it from tasting too heavy.
Return the shrimp. Add the cooked shrimp and any juices back to the pan.
Toss to coat and warm through for 1–2 minutes. Don’t overcook—shrimp can turn rubbery fast.
Prepare your base. For zucchini noodles: quickly sauté in another pan with a little oil and salt for 1–2 minutes until just tender, then drain off any liquid. For shirataki: rinse well, boil 2–3 minutes, drain, and dry-sauté to remove moisture.
Serve. Plate the zucchini noodles or shirataki and spoon the creamy shrimp Alfredo on top.
Garnish with parsley and extra Parmesan.