Preheat oven to 375°F (190°C). Cook pasta shells in salted boiling water until al dente. Drain and set aside. Sauté shrimp and spinach: Heat olive oil in a skillet over medium heat. Add garlic and cook until fragrant (about 30 seconds). Add shrimp, season with salt and pepper, and cook until pink (about 2–3 minutes). Add spinach and cook until wilted. Remove from heat and let cool slightly.
Prepare the filling: In a large bowl, combine ricotta, Parmesan, half of the mozzarella, egg, shrimp-spinach mixture, Italian seasoning, and red pepper flakes. Mix well until combined.
Assemble the shells: Spread half of the Alfredo (or marinara) sauce in a baking dish. Stuff each pasta shell with about 2 tablespoons of the shrimp-spinach filling and place in the dish. Pour the remaining sauce over the stuffed shells. Sprinkle the top with the remaining mozzarella and extra Parmesan.
Bake: Cover the dish with foil and bake for 20 minutes. Remove foil and bake uncovered for another 10–15 minutes, until golden and bubbly.