Cook the fettuccine: Bring a large pot of salted water to a boil. Add fettuccine and cook according to package instructions (8-10 minutes for al dente). Drain, reserving 1/2 cup pasta water, and set aside.
Sauté the shrimp: Heat 1 tbsp olive oil in a large skillet over medium-high heat. Season shrimp with salt, pepper, and 1/2 tsp smoked paprika. Sauté for 2-3 minutes per side until pink and opaque. Remove and set aside.
Cook the aromatics: In the same skillet, add remaining 1 tbsp olive oil. Sauté garlic and shallot for 1-2 minutes until fragrant. Add cherry tomatoes and cook for 3 minutes until softened.
Deglaze and build the sauce: Pour in white wine (or broth) and simmer for 2 minutes. Stir in heavy cream, lemon zest, lemon juice, oregano, and red pepper flakes. Simmer for 5 minutes until thickened.
Combine ingredients: Add cooked fettuccine and shrimp back to the skillet. Toss to coat, adding reserved pasta water (1 tbsp at a time) if needed. Stir in Parmesan cheese, if using, until melted.
Garnish and serve: Remove from heat. Sprinkle with parsley, basil, and black pepper. Serve with lemon wedges.